Climate
Investigators from the Harvard Business School, Indiana University School of Public Health, and the University of San Francisco’s Department of Medicine found that 41.2% of 3,512 hospitals and 302 hybrid health records were unable to receive electronic COVID-19 surveillance data, demonstrating a crucial need for IT infrastructure in public health management of COVID-19.
Epidemiology
In a retrospective study of 72 COVID-19 patients admitted to the Beijing YouAn Hospital between January 21 and February 17, 2020 patients with severe and critical disease showed significantly lower lymphocyte counts and significantly higher leukocyte counts, neutrophil counts, and neutrophil-to-lymphocyte ratio at each time point when compared to patients with milder disease.
Swedish researches conducted a prospective cohort study finding a negative correlation between odor intensity and COVID-19 symptoms adding to recent reports that odor intensity may be a cost effective, easily implement method of estimating COVID-19 prevalence particularly in areas with limited access to testing. Radiologists from Marseilles, France briefly present the case of a SARS-CoV-2 positive 27-year-old who developed anosmia and dysgeusia with MRI showing bilateral olfactory bulb edema.
A mathematical iSAGE model estimated that the risk of COVID-19 can be reduced from 1.46% to 0.72% if the start dates for England schools is delayed from the first of June the first of September.
Understanding the Pathology
A case control study conducted at Northwestern University using 16 placental specimens from patients with severe COVID-19 found higher rates of maternal vascular malperfusion (MVM) and arterial arteriopathy, but no significant increase in acute or chronic inflammatory pathology when compared to controls, suggesting the importance of antenatal surveillance for these patients.
A series of 10 autopsies on patients who died of COVID-19 in Sao Paulo, Brazil demonstrate damage to both epithelial and vascular tissues of multiple organ systems in COVID-19 including lungs, kidneys, spleen, lymph nodes, brain, testicles, and skin and fibrinous thrombi in the lungs of 80% of patients.
An analysis of angiotensin converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) transcriptome data from the Common Fund's Genotype-Tissue Expression (GTEx) Program found that ACE2/TMPRSS2 were expressed in salivary glands of healthy individuals with no significant variability between gender and age groups, suggesting a possible entry point for SARS-CoV-2
Transmission and Prevention
Researchers from the Chinese CDC outline disinfection techniques for hospital waste and wastewater suggest chlorine-based disinfection for hospital wastewater and incineration of pharmaceutical/chemical waste.
Management
Guidelines and recommendations for managing COVID-19 patients include:
Disease response protocol for healthcare systems
Treatments for immunosuppressed kidney transplant patients
A prospective cohort study observing 5,279 COVID-19 patients in New York found that while age and co-morbidities were predictive of hospital admission, oxygen saturation and markers of inflammation may be predictive of critical illness and mortality
European experts posit that PARP inhibitors (PARPi’s) may be beneficial in COVID-19 by moderating the sequelae associated with cytokine storms and ventilator-related injury and in preventing replication of SARS-CoV-2.
Anti-inflammatory effects of PARPi’s included the prevention of asthma and lung fibrosis in animal models and decreased expression of IL-6 in the lungs of animal models and in human serum, though less evidence was available to support the authors' position regarding viral replication.
The authors concluded that PARPi’s are safe and warranted clinical trials to evaluate their effectiveness in COVID-19 and ARDS.
Adjusting Practice
Guidelines and recommendations for practice from today include:
Ventilation techniques and transmission risk from the WHO
Telehealth for the pediatric gastroenterologist
Use of ultrasonic scalpels in head and neck surgery
A retrospective cross-sectional study conducted at a Northern Italian hospital during the peak of the pandemic found a 51% reduction in admission rates for severe emergent cardiovascular diseases suggesting that public fear of infection with COVID-19 may be leading to significantly reduced care-seeking.
A study in Canada of over 1,000 patients with polypharmacy found that almost 60% were currently prescribed drugs that exhibit adverse drug interactions with hydroxychloroquine suggesting the importance of considering current prescriptions when treating COVID-19
R&D
A retrospective case-series of 30 pediatric patients found that COVID-19 may appear predominantly as ground-glass opacities in a bilateral, peripheral, and lower-lobe distribution in pediatric patients; however, there was a significant rate of negative CT findings (77%) suggesting minimal utility of CT in children, especially those who are young or with mild symptoms.
Authors in Italy and China discuss the use of escin, a botanically derived compound with anti-viral properties against SARS-CoV-2 and respiratory syncytial virus (RSV), that could work synergistically with glucocorticoids to induce an anti-inflammatory response and reduce acute lung injury (ALI).
Mental Health and Resilience needs
Researchers at the University of Michigan present a multi-pronged approach to support older adults during the COVID-19 pandemic that includes increased at-home acute and primary care, assisted telehealth support, relationship-building and intergenerational programming, and building aging-friendly physical and social environments.
Silver Linings
An online survey of dermatologists in India and Switzerland claimed that telemedicine was an “an excellent tool for triage and disaster management” but found it slightly more difficult to make diagnoses.
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